CLINICAL
TRAINING:
Clinical Training is provided for students simultaneous with the theory part of the course Nursing Care of
the (ADULT HEALTH NURSING 2- NUR 304). Students are scheduled in the Nursing Skills Laboratory, and
Training Hospitals to develop their competencies in the management of adult clients experiencing
alterations in metabolic and endocrine function, urinary tract and renal functions, immunologic function,
neurologic function and musculoskeletal function and oncologic disorders in varied settings. Competencies
include the knowledge, skills and attitudes appropriate in the care and management of adult clients
experiencing alterations in metabolic and endocrine function, urinary tract and renal functions,
immunologic function, neurologic function and musculoskeletal function and oncologic disorders in varied
settings
The Clinical Training provides the opportunity for the students to develop their skills initially in the
laboratories and eventually manage an actual patient in the hospital settings under the supervision of
Clinical Instructors. The clinical training will enable the students to apply concepts/ theories learned in the
classroom. The Clinical instructors are responsible in bridging these concepts into the clinical setting.
Learning experiences are processed considering gaps between theory and practice.
CLINICAL OUTCOMES:
Throughout this clinical rotation, students are expected to:
1. Demonstrate critical thinking and decision-making skills when providing client care
2. Demonstrate sound knowledge and understanding of the components of basic sciences including,
human sciences, social sciences, health sciences, mathematics and the arts that underpin and
contribute to nursing practice and health promotion
3. Integrate knowledge and methods drawn from a variety of disciplines related to the nursing Kield to
informed decision making
4. Engage in ongoing evaluation of all care delivered, and change or suggest changes in plans for care
as appropriate to improve services, family care experiences and outcomes of care
5. Communicate and collaborate effectively both orally and in writing using a range of media that are
widely used in nursing and other health professions such as the writing and presentation of reports
to different types of audiences.
6. Demonstrate competence in numeracy skills necessary for safe patient and client care and
competence in providing safe and quality nursing care
7. Demonstrate professional relationships through inter-disciplinary, inter-agency and collaborative
activities to deliver evidence-based patient centered care to individuals, families, and communities
8. Practice nursing profession in a holistic, tolerant, non -judgmental, caring and sensitive manner that
recognizes and respects diversity and the beliefs, rights and wishes of those being cared for.
CLINICAL PLACEMENT:
Students are randomly assigned to clinical placements at:
1. King Salman Hospital – Northwestern Area, Tabuk
CLINICAL SCHEDULE:
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Each student trains 2 days per week throughout the semester. The Duration of the training is 120 hours.
Duty days for different groups are the following:
Day1: To be identiKied
Day2: To be identiKied
Day3: To be identiKied
Day4 To be identiKied
CLINICAL EVALUATION:
Clinical performance will be evaluated utilizing the clinical performance evaluation form, worksheets,
Nursing Care Plans and the clinical skills Audit. Each objective is critical and must be successfully met by
the end of the rotation. Students will receive formative and summative evaluation of their clinical
performance. Each student will receive a mid-semester and Kinal evaluation by the clinical instructor.
CLINICAL POLICIES
Attendance Policy
Faculty contact information is provided and should be used to contact instructor in advance of a clinical
absence. No third-party messages (i.e., from friend or classmate) will be accepted.
Dress Code
1. Nursing students will dress according to nursing department and/or agency policy and
demonstrate good personal hygiene.
2. Uniforms (navy blue scrub suit and white lab coat) should be clean and neat.
3. Students must wear their identiKication card at all times while inside the agencies during clinical
trainings.
4. White leather nursing or tennis shoes (no cloth shoes, open toe shoes, or clogs) with minimal
colored trim should be worn.
5. Fingernails must be short and clean. Nail polish and artiKicial nails should not be worn.
6. Jewelry is limited to wedding rings only.
Required Clinical Supplies
1. Watch with second hand
2. Stethoscope
3. Penlight
Students who do not adhere to the clinical dress code will have this documented on the clinical
evaluation tool as an unsatisfactory mark.
Clinical Skills:
Students are to seek help from the nurse preceptor and/or clinical instructor when they are unsure of
anything relating to the assignment and to ask for assistance with new or unfamiliar activities. A student
who is told to wait for the assistance is expected to do so. Students are expected to work within their
assignments, level of skills, and with appropriate supervision.
Students are expected to demonstrate selected psychomotor skills competently in lab prior to attending
clinical in a hospital. The number and type of skills that are available in the clinical facility are based on the
type of unit. For any clinical nursing skill the student must have direct supervision by the clinical faculty or
nursing staff when performing these skills, with the exception of personal care or taking vital signs.
Students are not permitted to perform any nursing skills without prior approval from the instructor and
direct supervision by a licensed professional. There may be an occasion that a nurse will offer an
opportunity for a student to complete a skill. In this circumstance, the student must seek approval from the
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clinical faculty prior to the initiation of these skills. The student may not perform any clinical nursing skills
without the express consent of the clinical faculty. In other words, the clinical faculty must be apprised of all
clinical activities at all times. Failure to follow these guidelines will result in immediate clinical failure.
You will be afforded the opportunity to do most nursing skill that presents itself, if you have previously
demonstrated the skill, and as your instructor believes you are capable and competent to perform. There
are certain functions you are never allowed to perform or perform without supervision. They are as
follows:
1. You cannot take phone orders (only licensed personnel are allowed this privilege).
2. You cannot hang blood or blood products (but may assist with initiating blood).
3. You cannot sign out narcotics.
4. You cannot administer chemotherapy.
5. You cannot administer ANY IV push drug, IV antibiotic, or IVF with additives without the direct
supervision of a licensed professional.
WRITTEN CLINICAL ASSIGNMENTS:
A late assignment will not be accepted unless prior arrangements have been made with the respective
faculty member. The grade for a late assignment may be adjusted downward by 5 percent per day the
assignment is late. Make up assignments for missed class/clinical days are at the discretion of the faculty.
Excessive late assignments will result in clinical failure.
Students who are unclear about assignments, expectations or any aspect of the course are
responsible for making an appointment with an instructor to receive clariRication in sufRicient time
to successfully complete the assignment.
1. Case Presentation (5% of clinical grade)
Students will work on a case presentation with their clinical group. Details for division into groups will be
provided by the clinical faculty. The presentation will focus on the completing a holistic, patient-centered
care plan that addresses actual or potential alternations in each body system. The group will use data
gathered during clinical sessions to construct a case scenario. Based upon the scenario assessment data,
students will create a nursing plan of care documented on clinical forms used throughout the clinical
experience. Each group will present the case scenario and plan of care during the Kinal class period.
Guidelines/rubric for the presentation will be posted on Blackboard or students emails no later than
midterm.
2. Clinical Worksheets & Care Plan Packet (40 % of clinical grade)
Students are required to complete a clinical worksheet packet for one assigned patient (one clinical work
sheets per Hospital, each clinical worksheet worth10 points)). This form should be completed with hospital
rotation. The clinical packet is available on Blackboard or will be send through email to students.
Students are required to submit a care plan for a patient they have been assigned (two care plans in each
hospital), using the approved care plan format. The guidelines and template for care plan are available on
Blackboard or will be send via email. Students will have a total of 4 care plans due during their clinical
training, each worth 10 points.
3. Clinical Skills audit (5%):
This form is designed to provide a guideline for the students during the training period in the assigned
hospital. The form includes a list of major skills/procedures to ensure the achievement of clinical objectives
of each speciKic unit. The form is kept by the Nurse student. After completion of task, it is the responsibility
of the student to check and to take the signature from immediate staff nurse trainer (preceptor) and submit
to the clinical instructor at the end of the clinical training.
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Summary of Clinical Grade: (Clinical grade is 100% of the course grade)
OSCE 1 10%
Worksheets & Nursing Care Plans 40%
Case presentation 5%
Clinical Performance Evaluation 10%
Clinical Skills audit 5%
OSCE 2 10%
Final written exam 20%
Total 100%
BrieRing and DebrieRing:
The clinical instructor about the clinical objectives, guidelines, requirements, evaluation, schedule, and
hospital policies gives orientation. Each student is required to have this orientation. BrieKing about the
clinical focus is done each week. The clinical instructor before the end of the duty conducts a debrieKing
each week.
Clinical instructors will provide feedback regarding requirements submitted and the weekly performance
of the student.
GUIDELINES FOR THE CLINICAL ASSIGNMENTS
OVERVIEW
• Clinical documents should be typewritten and submitted per the clinical assignment schedule
on the approved forms.
• The clinical worksheet should be completed in its entirety for one (1) assigned patient.
Unknown, unavailable, or not applicable information should be indicated using the
abbreviations UNK = unknown, UNA = unavailable, or N/A = not applicable.
CARE PLAN INFORMATION
ASSESSMENT DATA
In the Subjective Data list, relevant data includes (examples):
• client complaints
• description of the client's support system
• client awareness of her/his own abilities/disabilities disease process
• client’s stated health care needs
In the Objective Data list, relevant data includes:
• physical assessment data such as vital signs, skin condition, range of mobility, indicators of
nutritional status, etc.
• chart information including lab and test results
• objective assessments of mental state as well as physical Kindings, including such
information as facial expressions (e.g., grimaces when family is discussed; stares at Kloor
and makes no eye contact while speaking), body movements (clenches Kists throughout day;
rocks back and forth in chair throughout group therapy sessions); general behaviors (e.g.,
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stayed in room until 11:00AM on this shift; when out of room, stood in a corner of hallway
furthest away from people)
• observations of support systems in action
• information on the client's readiness for learning and learning potential
NURSING DIAGNOSES
The nursing diagnosis should be written for the top priority identiKied for the client. The nursing
diagnosis must be an approved NANDA nursing diagnosis.
When creating the care plan; write the diagnosis with the highest priority Kirst. There should be 1
diagnosis for each care plan.
Select only diagnoses that are amenable to resolution by nursing actions (no collaborative
problems).
Write out the three parts of the Nursing Diagnosis:
1. Statement of the actual or potential problem: this is a nursing diagnosis; not a medical
diagnosis;
2. Related to: the etiology must be amenable to nursing interventions. As most human responses
are related to several factors, each factor must be listed, e.g.
Acute pain related to:
I. Fracture of the left femur secondary to automobile accident (unrestrained passenger)
II. Non-displaced fracture of the 9th rib secondary to automobile accident (unrestrained
passenger)
III. Avulsion wound of the left lower leg secondary to automobile accident (unrestrained
passenger)
3. As evidenced by (AEB): the subjective and objective data that supports the diagnosis.
BE SPECIFIC, e.g. patient actual statements, B/P 142/70, guarding behavior when nurse
approaches bed, etc.
CLIENT GOALS
Number each goal.
As with nursing diagnoses, goals include three parts:
1. Statement of client-centered goal, stated in terms of client achievement, e.g.
“The client will maintain minimum pain level
2. As measured by: each goal must be measurable, with clear indication of how it will be
measured, e.g.
“as measured by description of pain level at 3 or less on a pain scale of 1-10”.
3. To be evaluated by: each goal must state a target date and hour for evaluation, e.g.
“by 3p.m. March 12, 2006 (specify date, hour).”
There are two levels of goals: long-term and short-term.
• Long-term goals (LTGs): LTGs are directed toward:
1. Promoting wellness
2. Preventing disease
3. Promoting recovery
4. Facilitating coping
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o The time frame for evaluation of LTGs will likely extend beyond the due date for
the Care Plan.
o The long term goals should focus on the identiKied PROBLEM.
• Short-term goals (STGs): STGs often denote immediate steps that lead toward fulKillment of
LTGs
o Time set for evaluation should be within relatively short.
o The short term goals should focus on the etiology (r/t factors)/inKluencing
factors.
Develop at least one STG and one LTG for each nursing diagnosis with follow-through for
evaluation when you are on the unit, i.e. (will demonstrate effective use of splinting techniques
using a pillow by 2pm on January 22, 2022)
NURSING INTERVENTIONS WITH SCIENTIFIC RATIONALE
After writing each goal, determine appropriate nursing interventions needed to achieve the goal. A
few points to remember:
• Interventions are nursing actions that are speciKic, not global. For example, “administer
pain medications” is too broad. A more speciKic alternative is:
o Assess pain response using a scale of 1-10 every two hours and as needed
o For pain on a scale of 4-6, administer Tylox 1-2 tabs every 4 hours as ordered
o For breakthrough pain and pain greater than 6, administer morphine sulfate 2 mg
IVP q 1-2 hours
o Demonstrate use of pillow as an agent to splint the ribs when coughing or turning
• In most cases, several nursing interventions are needed to achieve any one goal.
• There should be interventions to meet the LTG & the STG. The interventions for the LTG
should be focused on the problem, whereas the interventions for the STG should focus on
etiology/inKluencing factors.
• After each nursing action give the scientiKic rationale for selecting the action. Cite your
source for this rationale using APA format. Sources might include the medical-surgical
textbook, the pathophysiology textbook, research article, or discussion with an experienced
health care professional (see APA on how to cite personal communication).
• Rationale must be logical and relevant.
• Rationale must be in your own words using professional language or properly cited
according to APA methods
EVALUATION OF THE PLAN
For STGs:
State when goal is evaluated and be sure evaluation is congruent with time designated in the
statement of the goal. Also be sure to use the measures designated for goal achievement to state
client's degree of success, e.g,
“Client has experienced a decrease in level of pain as veriKied by self-evaluation of
anxiety as 4 on the 10-point pain scale when re-administered at 1:00 p.m. on
1/22/15.”
• (If goal is not accomplished, alternative is: “2 tablets of tylox were insufKicient
to maintain pain at less than 6. Administered 2 mg of IV morphine sulfate and
will monitor response at 1:30 p.m.”)
Determine effect of nursing interventions in accord with goal outcome, e.g.
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“Client stated that being able to splint her ribs when she coughed signiKicantly
helped to decrease pain.’”
• (If goal is not accomplished, alternative is: “Client had difKiculty using
the pillow to splint her ribs due to her anxiety about the pain. Will
assist family member to splint using the pillow.”)
Note what changes or continuations with nursing interventions are needed to achieve goal, e.g.
“Continue to monitor pain level and use morphine for breakthrough pain; Begin
instruction of relaxation techniques including deep breathing to assist with anxiety
created by pain.
• (If goal was not accomplished, alternative is: contact the orthopedic
surgeon to discuss alternative pain medications that may better
manage pain. Explore with client additional comfort measures that
have worked in the past.)
For LTGs:
Although LTGs will probably not be achieved before the Care Plan is submitted, they should be
evaluated as follows:
“Evaluation of this goal is set for (state the date & time). The client has made (no)
(some) (signiKicant) progress toward this goal: (describe any movement toward the
goal)."
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Care Plan Grading Rubric
Exceeds Standard Meets Standard Below Standard
Assessment 1.86-2 points 1.5-1.85 points 1.49-0 points
2pts Includes relevant Limited data to support Data is incomplete and/
subjective and objective nursing diagnosis. or does not support
data. Data supports nursing diagnosis.
nursing diagnosis.
Diagnosis 1.86-2 points 1.5-1.85 points 1.49-0 points
2 pts Diagnosis identiKies key Diagnosis stated without Diagnosis fails to
problem from presented etiology or contributing identify key problem.
assessment data. factors thoroughly Diagnosis not clearly
Diagnosis is clearly identiKied. stated with irrelevant
structured and includes etiology and/or
relevant etiology and contributing factors.
contributing factors.
Goals 1.86-2 points 1.5-1.85 points 1.49-0 points
2pts Goals are realistic, STG and LTG are realistic Goals are unrealistic
precise, and measurable. and precise. UnspeciKic and/or ambiguous.
Includes STG and LTG for time frame or method to Missing STG and/or LTG.
each diagnosis with measure outcome.
stated time frame.
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Interventions 1.86-2 points 1.5-1.85 points 1.49-0 points
2pts Interventions support Interventions support Interventions are
goals and are goals but are limited unclear and do not
comprehensive and and/or non-speciKic. support goal(s).
precise. Rationales included for ScientiKic rationale
Each intervention each intervention with incomplete and does not
includes scientiKic limited support. support intervention.
rationale. Clearly related
to intervention
Evaluation 1.86-2 points 1.5-1.85 points 1.49-0 points
2pts Clearly evaluates each Limited evaluation of Goal and/or
intervention and goal, interventions and/or intervention evaluation
with client response to goals. is incomplete.
goal. Includes necessary
revisions to plan of care.
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University of Tabuk
Faculty of medical Applied sciences
Nursing Department
Care Plan
Client Initials: Student name: ID:
Date:
Assessment Nursing DX/ Client Goals/ Nursing Interventions/ Evaluation
Clinical Problem Desired Actions/Orders and
Outcomes/ Rationale
Objectives
Subjective Problem(1p) Long Term: (1p) (1p) (1p)
(1p)
Objective R/T(0.5p) Short Term: (1p) (1p)
(1p)
(1p)
AEB(0.5p)
University of Tabuk
Faculty of medical Applied sciences
Nursing Department
Care Plan
Clinical Worksheet
Client Initials: ________ Student: ______________________________ Date of Care: ___________
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Demographic Health History Care Prescriptions
Information
Age: ____ Gender: ____ Chronic conditions & previous Nutrition
Nationality: ____ health problems: Type of diet: __________________________________
! NPO
Code Status: ________ ! Tube Feeds: Type ___________ Rate ________
! G tube ! NG tube
Weight: ____ Height: ! Aspiration risk ! Thickened liquids:
____ BMI: ____: the Type __________
patient is _____
Reason for Admission Unexpected events/complications Activity: ! Independent ! Assist !
[patient’s own words]: during hospitalization: Dependent
! Ad lib ! BR only ! Chair ! Ambulate
Previous surgeries: [type/ ! Bed Rest
year] ! Assistance of ___ (# of people)
Assistive devices:
! Gait belt ! mechanical lift ! walker !
Medical Diagnosis Nursing Diagnoses (5, prioritized, Elimination: ! Continent !
[medical terms]: with related factors): Incontinent
! Voiding ! Foley catheter ! I & O
! Enema ! Colostomy ! Other:
Skin Care:
! Intact skin ! Pressure ulcer stage:
__________
Date of admission: ! Other: ________ ! Turn & position w/ skin
care q. 2 hrs
Wound Care: ! Dressing/drain ! Drsg.
Allergies: Change/treatment
Location & Type______________________________
IV Site: Location ___________ Size: ___________
Pulmonary care:
Other notes: ! O2 ___ L/min via ! N/C ! mask !
on room air
! Incentive Spirometer q ___ hrs.
! MDI inhaler Mini-neb Med. !
albuterol ! atrovent
! Other
Glucometer: ! ac & hs ! other ____________
! sliding scale insulin,
every______hours
Discharge Plan/Long Term Needs:
Teaching Needs:
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Medications (scheduled & prn)
Name/Dose/ Class & Action Major Side Effects Nursing Implications Patient Education
Route
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Lab Values & Diagnostic Test Results
a. Important lab tests to monitor Why? (Consider diagnosis, pre-existing conditions, medications,
complications, etc.)
b. Hematology Normal values Patient’s Values (include serial labs) SigniRicance for
this patient
Date Date Date
WBC
Plt
Hgb
Hct
RBC
c. Chemistry Normal values Patient’s Values (include serial labs) SigniRicance for
this patient
K+
Na+
Cl-
CO2
BUN
Cr
Glucose
Albumin
d. Coagulation Normal values Patient’s Values (include serial labs) SigniRicance for
this patient
PT
INR
PTT
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e. Urine Normal values Patient’s Values (include serial labs) SigniRicance for
this patient
Color
Appearance
Spec. gravity
PH
Glucose
Ketones
Nitrates
RBCs
WBCs
Casts
Protein
f. ABGs Normal values Patient’s Values (include serial labs) SigniRicance for this
patient
pH
PaCO2
HCO3
PaO2
SaO2
g. Other Normal values Patient’s Values (include serial labs) SigniRicance for this
patient
h. Pertinent radiological studies:
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i. Other diagnostics (e.g. ECG, EEG, echo):
Patient Assessment & Nurses Notes
VS: (P,T,RR,BP,PO2,Pain)
Neuro: (GCS, Pupil size,….)
Musculoskeletal: (Strength, movement, coordination,….)
Skin: (Color, warmth, texture, abnormalities,…)
Cardiac: (Cardiac & peripheral pulses for rhythm, sounds, strength,…)
Pulmonary: (auscultation, airway clearance, breathing pattern, respiratory therapy,…etc)
GI/Nutritional Status: (appetite, food consumption, bowel sound, bowel motion, NPO status, type of diet, disorders,..)
GU/Reproductive: (Continence, abnormalities,…)
Psychosocial: (anxiety level, social interaction, family support, body image, psychological disorders,…)
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Date/ Nurses Notes
Time
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